Evaluation of obstetric early discharge - economic evaluation, CHERE Discussion Paper No 12

Obstetric early discharge provides an alternative to conventional, hospital based, postnatal care. Clients are discharged around two days earlier than usual and followed up at home by a midwife for up to seven days after delivery. Although previous evidence has shown that health status is at least equivalent in both alternatives, clients have an increased choice of their location of postnatal care. The primary objective of the economic evaluation is to estimate the net economic value of resources released due to the early discharge scheme in operation at three hospitals in Western Sydney. At current levels of activity the early discharge schemes at Blacktown and Westmead Hospitals use more hospital resources than they release. The Auburn early discharge scheme is the only one which releases resources in excess of the cost of domiciliary midwifery care, but this result is extremely sensitive to changes in key assumptions used in the analysis. Strategies which may improve the cost-effectiveness of each early discharge scheme are examined. The results also show that the burden of care has shifted to the community for all three schemes. When client and community related resource use is included in the results all three schemes consume more resources than they release. The ability of all three schemes to release resources may be eroded if lengths of conventional postnatal stay continue to fall in the future. This may also affect health outcomes if women are sent home early without midwifery support. Further research should be carried out on the effects on maternal and infant health status, not only of the declining trend in length of stay, but also of the number of postnatal visits received by each early discharge client. The study results indicate that even if early discharge schemes release resources greater than the cost of domiciliary midwifery care, it does not guarantee reductions in hospital expenditure. This depends on the alternative use to which the released resources are directed. Obstetric early discharge schemes provide clients with greater choice, and are likely to improve the quality of postnatal care. The main issue for decision makers is whether increased client choice is worth the extra cost of the domiciliary midwifery program.